Code of Federal Regulations Title 42. Public Health § 42.423.2112 Content of request for review

(a)(1) The request for Council review must be filed with the entity specified in the notice of the ALJ's or attorney adjudicator's action.

(2) The request for review must be in writing and may be made on a standard form, except for requests for expedited reviews which may be made orally.

(3) The Council must document all oral requests in writing and maintain the documentation in the case file.

(4) A written request that is not made on a standard form or, for expedited requests, an oral request, is accepted if it includes the enrollee's name and telephone number, the plan name;  Medicare number;  the ALJ appeal number;  the specific Part D drug(s) for which the review is requested;  a statement that the enrollee is requesting an expedited review, if applicable;  and the name of the enrollee or the representative of the enrollee.